Solid tumours in children make approximately 1 – 1.5% of all cancer cases. In the treatment of childhood cancers the late side effects, rather than acute side effects, are of crucial importance, given the excellent treatment results achieved by complex cancer therapy. The expected side effects of radiotherapy depend on the irradiated area and the dose administered. Once emerged, most of the severe adverse effects are not causally influenced by any treatment, and their prevention is of the utmost importance. Ways are being sought to reduce risks associated with treatment. In the case of radiotherapy, it is the attempt to minimise the dose to healthy tissue and organs, while ensuring a sufficient dose is delivered to the target volume. This is in many cases very difficult to achieve when using photon radiation. Therefore the way to overcome this is the inclusion of proton therapy in the treatment regime of paediatric patients.
Childhood tumours are one of the ‘traditional’ indications for proton therapy. A number of studies addressing the safety and efficacy of proton therapy for paediatric tumours, as well as the adverse effects of treatment have been published, in which more than 1,000 children were enrolled, with more being rapidly added.
Due to its advanced and highly precise method of radiotherapy, proton treatment is associated with the sparing of the tissue “in front of the tumour” (from the perspective of the radiation source) and in particular beyond the tumour. In this way, it is possible to deliver the prescribed dose to the target volume while sparing the healthy tissue (as compared to photon radiation), improve the toxicity, and improve the quality of life of paediatric patients.
In paediatric patients proton therapy clearly demonstrates:
- Reduced incidence of secondary malignancies
- Reduced amount of growth abnormalities
- Reduced hormonal dysfunction
- Reduced levels of cognitive impairment
- Reduced risk of future fertility issues
- Reduce the incidence of acute adverse effects such as radiation mucositis, pneumonitis, and gastroenteritis.
- A variety of other benefits related to the area of irradiation, such as a reduction in the effect to the sensory functions
The Proton Therapy Center in Prague is active in international cooperation in the field of paediatric proton therapy. The centre draws on the experience of other centres which have been in operation for longer, and also shares its own know how and experience with the most advanced technology – pencil beam scanning.